Question: When educating a client about their medication, Selegiline, what risk should the nurse explain?
Answer Options: Hypertensive crisis due to ingestion of tyramine.
Answer: Hypertensive crisis due to ingestion of tyramine.
Question: A nurse is caring for a client who has borderline personality disorder. Which interventions should the nurse consider as anticipated, nonessential, contraindicated, or nonsense?
Answer Options: Various interventions aimed at managing behavior and emotions.
Answer: Anticipated interventions include encouraging the client to self-reward for positive outcomes, writing in a journal, and communicating behavioral expectations with the client’s family.
Question: A nurse is caring for a school-age child who has pertussis. Which of the following actions should the nurse take?
Answer Options: Restrict oral fluids to 500 mL per day, Report the diagnosis to the public health department, Place the child in a protected environment for 48 hr., Administer the pertussis vaccine.
Answer: Report the diagnosis to the public health department.
Question: A nurse is caring for a 7-year-old child who has a urinary tract infection (UTI). Which interventions are anticipated or contraindicated?
Answer Options: Educate about proper perineal hygiene, Advise about sunscreen use, Administer sulfamethoxazole and trimethoprim, Administer salicylic acid for pain and fever, Ensure fluid intake.
Answer: Educate about proper perineal hygiene, Administer sulfamethoxazole and trimethoprim, Administer salicylic acid for pain and fever, Ensure fluid intake.
Question: A nurse on a pediatric intensive care unit is caring for a toddler who is postoperative following open heart surgery. Which of the following findings should the nurse report to the provider?
Answer Options: Urine output of 15 mL in the last 2 hr, Skin temperature 36°C, Pedal and posterior tibial pulses of 2+, Drainage from the chest tube of 22 mL in the last hour.
Answer: Urine output of 15 mL in the last 2 hr.
Question: A nurse is assessing a school-age child who is receiving morphine. Which of the following adverse effects should the nurse monitor?
Answer Options: Prolonged wound healing, Stevens-Johnson syndrome, Nausea, Renal failure.
Answer: Nausea.
Question: A nurse is providing teaching to the parent of a school-age child who has a maintenance prescription for prednisone following an acute asthma attack. Which statement by the parent indicates an understanding of the teaching?
Answer Options: Weekly blood test, Withhold medication before activity, Decreased appetite, Experience mood swings.
Answer: Experience mood swings.
Question: A nurse is caring for a school-age child who has heart failure. Which of the following findings should the nurse expect?
Answer Options: Tachycardia, Weight loss, Cyanosis, Dyspnea, Bounding pulses.
Answer: Tachycardia, Cyanosis, Dyspnea.
Question: A nurse is caring for a child whose guardian requests information about essential oils to help their child relax. Which of the following oils should the nurse recommend?
Answer Options: Lavender, Tea tree, Jasmine, Eucalyptus.
Answer: Lavender.
Question: A nurse is assessing a child who has heart failure. Which of the following is a clinical manifestation associated with this diagnosis?
Answer Options: Increased appetite, Tremors, Tachypnea, Bradycardia.
Answer: Tachypnea.
Question: A nurse is preparing to administer recommended immunizations to a 12-month-old infant who is up-to-date with the current schedule. Which of the following immunizations should the nurse plan to administer?
Answer Options: Varicella, Herpes zoster, Rotavirus, HPV, MMR.
Answer: Varicella, Rotavirus, MMR.
Question: A nurse is caring for a preschool-age child who is postoperative following a tonsillectomy and is clearing her throat frequently. Which of the following actions should the nurse take first?
Answer Options: Administer an analgesic, Observe the child’s throat with a flashlight, Give the child small sips of water, Offer an ice collar.
Answer: Observe the child’s throat with a flashlight.
Question: A nurse is teaching home care to the parents of a preschool-age child who has heart failure. Which of the following information should the nurse include in the teaching?
Answer Options: Provide rest, Weigh monthly, Withhold digoxin if pulse >100, Increase oxygen rate.
Answer: Provide for periods of rest.
Question: A nurse is caring for an 8-year-old child who was recently diagnosed with chronic renal failure. The child’s parents ask for information on hemodialysis. Which statement should the nurse make?
Answer Options: Uses an artificial membrane, Uses abdominal cavity, Uses electrolyte solution, Slow filtration.
Answer: Uses an artificial membrane outside the body.
Question: A nurse is caring for a school-age child who has diabetes mellitus. Which of the following findings should the nurse recognize as being consistent with hyperglycemia?
Answer Options: Sweating, Pallor, Tremors, Thirst.
Answer: Thirst.
Question: A nurse is providing teaching to a 15-year-old adolescent about a medication used to treat a sexually transmitted infection. Which of the following actions should the nurse take?
Answer Options: Instruct parents, Provide instructions with parent present, Ask learning preferences, Contact pharmacy.
Answer: Ask how the client prefers to learn new information.
Question: A nurse is caring for a school-age child who is having a tonic-clonic seizure. Which of the following actions should the nurse take?
Answer Options: Time the episode, Administer chlorothiazide, Hold the child down, Place in prone position.
Answer: Time the episode.
Question: A nurse is assessing a 5-month-old infant. Which of the following findings should the nurse report to the provider?
Answer Options: Exhibits head lag, Unable to hold a bottle, Absent grasp reflex, Unable to roll.
Answer: Absent grasp reflex.
Question: A nurse is providing discharge teaching to the guardian of a child who has cystic fibrosis. Which of the following statements should the nurse include?
Answer Options: Chest X-rays, Tonsil removal, Pancreatic enzymes, Isoniazid.
Answer: Your child should take pancreatic enzymes with meals and snacks.
Question: A nurse is caring for a 3-year-old child.
Answer Options: Temperature, Irritability, Stridor, Cough findings at 0800
Answer: Acute laryngotracheobronchitis for Irritability, Stridor, and Cough findings at 0800.
Question: A nurse is reviewing the child’s medical record.
Answer Options: Water-soluble vitamins, Acetaminophen, Meperidine, Pancreatic lipase, Dornase alfa
Answer: Water-soluble vitamins, Pancreatic lipase, Dornase alfa
Question: A nurse is planning care for the adolescent.
Answer Options: Administer meperidine IV for pain, Administer folic acid as prescribed, Instruct the parent to ensure the pneumococcal vaccine is current, Give oral hydroxyurea, Place the client on strict bed rest, Monitor oxygen saturation continuously, Restrict oral intake, Apply cold compresses to the affected joints.
Answer: Administer folic acid as prescribed, Instruct the parent to ensure the pneumococcal vaccine is current, Give oral hydroxyurea, Place the client on strict bed rest, Monitor oxygen saturation continuously
Question: A nurse is caring for a 6-week-old infant.
Answer Options: Implement contact precautions, Place nasogastric tube for gastric decompression, Anticipate a prescription for digoxin, Elevate the head of the bed to a 45° angle, Provide chest physiotherapy and postural drainage.
Answer: Congestive heart failure: Place nasogastric tube for gastric decompression, Provide chest physiotherapy and postural drainage; Monitor respiratory status, Peripheral pulses.
Question: A nurse is caring for a child who has disseminated intravascular coagulation.
Answer Options: Increased Hgb level, Increased RBC, Decreased prothrombin time, Decreased platelet count
Answer: Decreased platelet count
Question: A nurse is providing discharge teaching to the guardian of a preschooler who had a tonsillectomy.
Answer Options: Notify the provider if your child is swallowing frequently, Encourage your child to clear their throat as needed, Notify the provider if your child has dark brown blood between their teeth, Encourage your child to drink liquids through a straw.
Answer: Notify the provider if your child is swallowing frequently
Question: A nurse is providing teaching about injury prevention to the parents of a toddler.
Answer Options: Place screens on all windows, Adjust the water heater temperature to 54°C (129.2°F), Check clothing for loose buttons, Provide balloons for play.
Answer: Adjust the water heater temperature to 54°C (129.2°F)
Question: A nurse is providing teaching to the parent of a toddler who is scheduled for an electrocardiogram.
Answer Options: This procedure will take at least 30 minutes to complete, Leads will be placed on your child’s back prior to the procedure, Your child can rest on your lap during the procedure, An alarm will sound if your child has an abnormal heart rhythm.
Answer: Your child can rest on your lap during the procedure